Volunteering as prosocial behaviour by medical students following a flooding disaster and impacts on their mental health: A mixed-methods study.

BACKGROUND: Volunteering is a form of prosocial behaviour that has a been recognised as having positive benefits for medical students. However, there is a lack of research on what influences students to volunteer during and after weather-related disasters. Our study (1) explores factors related to medical students' willingness and readiness to volunteer, and (2) describes mental health impacts of the flood events on students. METHODS: We conducted a mixed-methods study of medical students on rural clinical placements in a regional area of Australia, 2 to 6 weeks after two major flooding events in 2022. Data were collected through survey and focus groups. Summary statistics were generated from the survey data, and Fisher's exact test was used to determine associations between student experience of the flood and self-rated well-being. Qualitative data were deductively analysed using Byrne and colleagues' theory of prosocial behaviour during an emergency. RESULTS: The 36 students who participated in focus groups (including the 34 who completed the survey) (response rates 84% and 79%, respectively) demonstrated high levels of prosocial behaviours and were willing to volunteer. A sense of moral obligation was the primary reason for volunteering, whereas concerns for their physical and psychological safety, and missing key aspects of their training, were the strongest reasons for not continuing to volunteer. Students reported personal stress, anxiety and trauma during this period, with significant associations between self-rated impacts on their well-being and feelings of being terrified, helpless and hopeless during the flooding events and of still being distressed weeks later (p < .05). CONCLUSIONS: This study expands on prosocial behaviour theory by applying Byrne and colleagues elaborated model in the context of medical student volunteering during the 2022 major flooding events in Australia. Modifiable barriers to prosocial behaviour are identified along with proposed strategies to address these barriers.

Reducing avoidable admissions in rural community palliative care: a pilot study of care coordination by General Practice registrars.

OBJECTIVE: To investigate the feasibility of using a General Practice registrar (GPR) to coordinate rural palliative care services. DESIGN: A quasi-experimental design was used. Intervention group participants received the GPR service, which involved liaison among the patient, family, General Practitioner, specialist palliative care team and community nurses. Specified risk assessment, care planning and continuity of care were provided. Patients in the comparison group received the standard service. SETTING: Rural community palliative care. PARTICIPANTS: One hundred and ninety-one rural community palliative care patients (99 intervention and 92 control patients). MAIN OUTCOME MEASURES: Hospital admissions per 100 patient-days, bed-days per 100 patient-days and proportion of deaths at home. RESULTS: Patients receiving standard care were twice as likely to spend ≥8 bed-days in hospital (OR 2.09 (95%CI 1.10-3.97); P = 0.02) and were more likely to have ≥ 2 admissions to hospital (OR 3.37 (95%CI 1.83-6.21); P < 0.001), per 100 patient-days than the intervention group after adjusting for diagnosis group (cancer or not) and residence in residential aged care. Controls were significantly less likely to die at home than the intervention group (OR 0.41 (95%CI 0.20-0.86); P = 0.02). CONCLUSION: This is a small proof of concept pilot study limited by lack of randomisation. The results demonstrate the feasibility of using a GPR to manage continuity of care for rural community palliative care patients. Given the potential confounding factors, further investigation via a larger randomised trial is required.

General practitioners as educators in adolescent health: a training evaluation.

BACKGROUND: General practitioners play an important role in the primary care of adolescents in both community and clinical settings. Yet studies show that GPs can lack confidence, skills and knowledge in adolescent health. This study evaluates the effectiveness of an innovative training intervention on medical participants' knowledge and confidence as adolescent health educators in a school setting. METHODS: 15 general practitioners, 12 general practice registrars and 18 medical students participated in an adolescent health education workshop followed by field experience in health education sessions in secondary schools. The mixed method design included a pre and post intervention survey and focus group interviews. RESULTS: Mean scores on the Confidence to Teach scale increased significantly (3.34 ± 0.51 to 4.09 ± 0.33) (p < .001) as did confidence to communicate with adolescents (3.64 ± 0.48 to 4.19 ± 0.33) (p < .001). Mean knowledge scores increased significantly (7.00 ± 1.22 to 8.98 ± 1.11) (p < .001). Participants highlighted the value of learning about adolescent health issues and generic teaching skills especially lesson planning and design, practicing experiential teaching strategies and finding the 'sweet spot' when communicating with adolescents. Some participants reported that these skills would transfer to the practice setting. CONCLUSION: An applied training intervention that uses evidence-based, experiential teaching strategies and focuses on developing knowledge and practical teaching skills appropriate for the health education of adolescents can enhance knowledge and confidence to engage in community-based adolescent health education.

Supporting near-peer teaching in general practice: a national survey.

BACKGROUND: Training bodies see teaching by junior doctors and vocational trainees in general practice (family medicine) as integral to a doctor's role. While there is a body of literature on teacher training programs, and on peer and near-peer teaching in hospitals and universities, there has been little examination of near-peer teaching in general practice. Near-peer teaching is teaching to those close to oneself but not at the same level in the training continuum. This study investigated the perceptions of key stakeholders on near-peer teaching in general practice, their current near-peer teaching activities, and methods of recruitment and support. METHODS: A national anonymous online survey was used to obtain data on Australian stakeholders' perceptions of, and processes related to, near-peer teaching in general practice. Recruitment occurred via electronic invitations sent by training providers and stakeholder associations. Separate questionnaires, which were validated via several cycles of review and piloting, were developed for supervisors and learners. The survey included both fixed response and open response questions. RESULTS: Responses (n = 1,122) were obtained from 269 general practitioner supervisors, 221 general practice registrars, 319 prevocational trainees, and 313 medical students. All stakeholder groups agreed that registrars should teach learners in general practice, and 72% of registrars, 68% of prevocational trainees, and 33% of medical students reported having done some teaching in this setting. Three-quarters of supervisors allowed learners to teach. Having another learner observe their consultations was the most common form of teaching for registrars and prevocational trainees. Eight percent of registrars received some remuneration for teaching. The approach used to determine teaching readiness and quality varied greatly between supervisors. CONCLUSIONS: Near-peer teaching was supported by the majority of stakeholders, but is underutilised and has poor structural support. Guidelines may be required to help supervisors better support learners in this role and manage quality issues related to teaching.

How effective and acceptable is Web 2.0 Balint group participation for general practitioners and general practitioner registrars in regional Australia? A pilot study.

OBJECTIVE: General practitioners (GPs) and general practice registrars report work-related stress. Balint groups may improve coping mechanisms. However, attendance at a face-to-face Balint group is difficult for rural doctors due to distance constraints. The study aim was to evaluate online Balint groups for rural doctors and determine effect size for a full-scale trial. DESIGN: A mixed-methods approach, including a pre-post controlled trial and thematic analysis of qualitative data. SETTING: Rural primary care. PARTICIPANTS: Thirteen GPs and 8 general practice registrars completed the study. INTERVENTIONS: Balint groups were delivered over 8-9 fortnightly online sessions. GPs and GP registrars participated in separate groups. Data were collected on work-related affect, psychological medicine skills and professional isolation using the Warr's Work-Related Affect Scale, the Psychological Medicine Inventory, and a professional isolation scale. MAIN OUTCOME MEASURES: Change scores on Warr's Work-Related Affect Scale, the Psychological Medicine Inventory, and a professional isolation scale. RESULTS: Balint participants' scores were significantly higher post-intervention on the Psychological Medicine Inventory (mean 6.49 (±0.20) versus 5.43 (±0.26); P < 0.01) and Warr's Work-Related Affect (mean 4.09 (±0.09) versus 3.60 (±0.12); P < 0.01) scales than control group scores. Effect size on these scales ranged from 0.46 to 0.50. The greatest challenge was technical problems related to insufficient broadband speed. CONCLUSIONS: Online Balint groups appear to improve rural doctors' psychological medicine skills and work-related affect. New data on effect size will inform a full-scale trial. Improved national broadband infrastructure may enhance online support opportunities for rural doctors.

Stakeholders' views of shared learning models in general practice: a national survey.

BACKGROUND: The number of learners requiring general practice placements creates supervisory capacity constraints. This research examined how a shared learning model may affect training capacity. METHODS: The number of learners requiring general practice placements creates supervisory capacity constraints. This research examined how a shared learning model may affect training capacity. RESULTS: A total of 1122 surveys were completed: 75% of learners had participated in shared learning; 25% of multi-level learner practices were not using shared learning. Learners were positive about shared learning (4.3-4.4/5), considering it an effective way to learn that created training capacity (4.1-4.2/5). 79-88% of learners preferred a mixture of one-to-one teaching and shared learning. Supervisors thought shared learning was more cost- and time-efficient, and created training capacity (4.3-4.4/5). DISCUSSION: Shared learning models have the potential to increase GP training capacity. Many practices are not utilising shared learning, representing capacity loss. Regional training providers should emphasise positive aspects of shared learning to facilitate uptake.

Vertically integrated shared learning models in general practice: a qualitative study.

BACKGROUND: The numbers of learners seeking placements in general practice is rapidly increasing as an ageing workforce impacts on General Practitioner availability. The traditional master apprentice model that involves one-to-one teaching is therefore leading to supervision capacity constraints. Vertically integrated (VI) models may provide a solution. Shared learning, in which multiple levels of learners are taught together in the same session, is one such model. This study explored stakeholders' perceptions of shared learning in general practices in northern NSW, Australia. METHODS: A qualitative research method, involving individual semi-structured interviews with GP supervisors, GP registrars, Prevocational General Practice Placements Program trainees, medical students and practice managers situated in nine teaching practices, was used to investigate perceptions of shared learning practices. A thematic analysis was conducted on 33 transcripts by three researchers. RESULTS: Participants perceived many benefits to shared learning including improved collegiality, morale, financial rewards, and better sharing of resources, knowledge and experience. Additional benefits included reduced social and professional isolation, and workload. Perceived risks of shared learning included failure to meet the individual needs of all learners. Shared learning models were considered unsuitable when learners need to: receive remediation, address a specific deficit or immediate learning needs, learn communication or procedural skills, be given personalised feedback or be observed by their supervisor during consultations. Learners' acceptance of shared learning appeared partially dependent on their supervisors' small group teaching and facilitation skills. CONCLUSIONS: Shared learning models may partly address supervision capacity constraints in general practice, and bring multiple benefits to the teaching environment that are lacking in the one-to-one model. However, the risks need to be managed appropriately, to ensure learning needs are met for all levels of learners. Supervisors also need to consider that one-to-one teaching may be more suitable in some instances. Policy makers, medical educators and GP training providers need to ensure that quality learning outcomes are achieved for all levels of learners. A mixture of one-to-one and shared learning would address the benefits and downsides of each model thereby maximising learners' learning outcomes and experiences.

Shared learning in general practice--facilitators and barriers.

BACKGROUND: Capacity for teaching in general practice clinics is limited. Shared learning sessions are one form of vertically integrated teaching that may ameliorate capacity constraints. METHODS: This study sought to understand the perceptions of general practitioner supervisors, learners and practice staff of the facilitators of shared learning in general practice clinics. Using a grounded theory approach, semistructured interviews were conducted and analysed to generate a theory about the topic. RESULTS: Thirty-five stakeholders from nine general practices participated. Facilitators of shared learning included enabling factors such as small group facilitation skills, space, administrative support and technological resources; reinforcing factors such as targeted funding, and predisposing factors such as participant attributes. DISCUSSION: Views from multiple stakeholders suggest that the implementation of shared learning in general practice clinics would be supported by an ecological approach that addresses all these factors.

'Learners as teachers' in general practice: stakeholders' views of the benefits and issues.

OBJECTIVES: To explore stakeholders' perceptions of learners teaching (near-peer teaching) in general practice in order to inform training policy. DESIGN: Qualitative semi-structured interviews were conducted with 29 general practice stakeholders. Interviews continued until data saturation was reached. Transcribed interviews underwent thematic analysis. SETTING: Nine general practices in NSW, Australia. PARTICIPANTS: Eleven general practitioner supervisors, eight general practice registrars, two prevocational general practice placement programme trainees, and eight medical students. RESULTS: Learners expressed positive attitudes towards learners teaching, and half were already teaching. Learners and supervisors felt near-peer teaching could enhance their own learning. Supervisors suggested near-peer teaching reduced time pressures on themselves, helped them to keep current, was a form of succession planning, and brought financial benefits to the practice. Having time to assess the capabilities of learners prior to allocating them teaching roles was considered important. Strategies suggested by learners to encourage near-peer teaching include asking learners to teach, mentoring, providing short but regular opportunities to teach, highlighting the clinical relevance of teaching skills, having longer placements for medical students, and allowing learners to teach in areas of interest, expertise or need. CONCLUSIONS: Participants looked favourably upon learners teaching in general practice, and felt it could enhance learning. Suggestions were made to facilitate near-peer teaching in general practice. Further quantitative research with a larger and more diverse sample is required to determine if these results can be generalised to the wider general practice population.

Evaluating a community-engaged vertically integrated teaching and learning pilot project.

OBJECTIVE: To evaluate a community engaged vertically integrated teaching and learning pilot project. METHOD: Thematic analysis of focus group interviews was used to examine 27 general practitioners' (GPs'), registrars' and medical students' perceptions of a vertically integrated workshop in adolescent health and subsequent small group health education sessions at two secondary schools. Pre- and postintervention surveys were used to measure changes to participants' knowledge, confidence, and attitudes towards registrars and students teaching in general practice. RESULTS: Knowledge scores (7.46 ± 1.17 vs 9.54 ± 1.17; t = -9.6, P <0.001), and scores on the Confidence to Teach (3.34 ± 0.51 vs 4.09 ± 0.33; t = -6.61, P <0.001), and Vertically Integrated Teaching (4.01 ± 0.40 vs 4.30 ± 0.42; t = -3.45, P <0.05) scales increased significantly following the intervention. Scale reliability ranged from 0.74 to 0.87. Participants enjoyed the collegiality of learning together in a vertically integrated model. The experience stimulated self-reflection on teaching skills and a desire for peer review of teaching. Suggestions for improving the intervention included building a clearer link between the facilitation skills learnt in the school setting and how to implement them in general practice, and providing more targeted support for GPs on facilitating sessions with multiple levels of learner involved. CONCLUSIONS: A community-engaged vertically integrated teaching and learning model has the potential to increase participants' confidence to teach in small groups, and create a more positive perception of registrars and students teaching in general practice. The concept would benefit from further longitudinal research with a wider sample.